Disaster preparedness for charge nurses: A program evaluation.

Over the last 3 years at a large, -midwestern, pediatric hospital, there have been near -disaster events, a few of which required transfer or evacuation of patients. The responses from the inpatient units to these events have varied greatly and can be traced back to communication, knowledge, comfort level, and effectiveness of the charge nurses on the nursing units. A task force was formed to understand the variation in their disaster response procedures and to standardize disaster response procedures. Respondents included the bedside, clinical leader-ship, managers of patient services, emergency preparedness management, and senior leadership. This resulted in the creation of a tabletop simulation exercise for use by inpatient charge nurses within the institution. The results indicated that participants reported higher levels of self-reported knowledge, confidence, and effectiveness regarding the disaster preparedness on their units (p < 0.001). The program was effective, with feedback from participants indicating the need for more frequent and/or department -specific education.

A Quantitative, Pooled Analysis and Systematic Review of Controlled Trials on the Impact of Electrical Stimulation Settings and Placement on Pressure Ulcer Healing Rates in Persons With Spinal Cord Injuries.

Pressure ulcers (PrUs) are among the most common secondary complications following spinal cord injury (SCI). External electrical current applied to a wound is believed to mimic the body's natural bioelectricity and to restart and stimulate endogenous electrical fields to promote wound healing. A systematic review was conducted to critically appraise and synthesize updated evidence on the impact of electrical stimulation (ES) versus standard wound care (comprising cleansing, dressing, nutrition, and debridement as necessary) and/or sham stimulation on PrU healing rates in persons with SCIs. Medline, Embase, the Cumulative Index for Nursing and Allied Health Literature (CINAHL), PsycINFO, and Cochrane Central were searched using the terms spinal cord injury, electrical stimulation, and pressure ulcer in free text and MESH terms. Publications were limited to peer-reviewed, randomized controlled trials (RCTs) and non-RCTs (CCTs) published in English from 1985 to 2014. The methodological quality of the RCTs was evaluated using the Jadad scale; CCTs were assessed using the Downs and Black tool. Pooled analyses were performed to calculate the mean difference (MD) for continuous data, odds ratio (OR) for dichotomous data, and 95% confidence intervals (CI). A total of 8 trials were reviewed - 6 RCTs and 2 CCTs included a total of 517 SCI participants who had at least 1 PrU. The number of patients per study ranged from 7 to 150 and the number of wounds from 7 to 192. Comparison models included ES irrespective of current type and placement of electrodes against sham/no ES (7 trials), ES delivered by electrodes overlaid on the ulcer versus sham/no ES (4 trials), ES delivered by electrodes placed on intact skin around the ulcer versus sham/no ES (4 trials), ES delivered by electrodes overlaid on the wound bed versus placed on intact skin around the ulcer (1 trial), ES with pulsed current versus sham/no ES (6 trials), ES with constant current versus sham/no ES (2 trials), pulsed current ES versus constant current ES (1 trial), number of PrUs closed (2 trials), and incidence of PrU worsened by ES versus sham/no ES (2 trials). The overall quality of studies was moderate; 2 trials were rated as good quality, 2 were poor quality, and 4 were moderate. Evidence showed ES increased the rate of PrU healing in patients with SCI (MD 4.97, 95% CI 1.97-7.98, P = 0.00; N = 7 studies and 559 ulcers), and a higher proportion of ulcers healed (OR 2.68, 95% CI 1.17-6.14, P = 0.02; N = 2 studies and 226 ulcers). The data suggest pulsed current ES increased the healing rate (MD 6.27, 95% CI 2.77-9.78, P = 0.0005; N = 6 studies and 509 ulcers) more than constant current (MD 4.50, 95% CI 1.19-10.18, P = 0.12; N = 2 studies and 200 ulcers). In addition, wounds with electrodes overlaying the wound bed seemed to heal ulcer faster than wounds with electrodes placed on intact skin around the ulcer. Future preclinical, in vivo models and clinical trials examining the impact of electrodes configuration for PrU healing are warranted.

A systematic review of electrical stimulation for pressure ulcer prevention and treatment in people with spinal cord injuries.

CONTEXT: Electrical stimulation (ES) can confer benefit to pressure ulcer (PU) prevention and treatment in spinal cord injuries (SCIs). However, clinical guidelines regarding the use of ES for PU management in SCI remain limited. OBJECTIVES: To critically appraise and synthesize the research evidence on ES for PU prevention and treatment in SCI. METHOD: Review was limited to peer-reviewed studies published in English from 1970 to July 2013. Studies included randomized controlled trials (RCTs), non-RCTs, prospective cohort studies, case series, case control, and case report studies. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring effectiveness of PU prevention and treatment was included. Methodological quality was evaluated using established instruments. RESULTS: Twenty-seven studies were included, 9 of 27 studies were RCTs. Six RCTs were therapeutic trials. ES enhanced PU healing in all 11 therapeutic studies. Two types of ES modalities were identified in therapeutic studies (surface electrodes, anal probe), four types of modalities in preventive studies (surface electrodes, ES shorts, sacral anterior nerve root implant, neuromuscular ES implant). CONCLUSION: The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention. Future research is suggested to improve the design of ES devices, standardize ES parameters, and conduct more rigorous trials.